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PRINTED: 10/12/2016 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION

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Printed Form 1027 is a tax form used for reporting certain income and expenses.

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Individuals or businesses who have specific types of income and expenses must file Printed Form 1027.

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Printed Form 1027 requires reporting of income sources, expenses, deductions, and any other relevant financial information.

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